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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The alteration in left and right ventricular (LV, RV) function during and immediately following coronary artery bypass surgery has been investigated in four studies, which are summarized here. In a total of 88 patients, anesthetized with morphine in oxygen (O2), basic hemodynamic monitoring and first pass radionuclide angiography were used to document changes in LV and RV function, LV compliance, and the effects of preload augmentation and afterload reduction on LV function. Two groups of patients with different physiologic responses were identified: those with preoperative ejection fractions (EF) greater than 0.50 and no dyssynergy (group I) and those with EF less than 0.50 or with dyssynergy (group II). In group I (n = 14), LV compliance was preserved following bypass (improved in four patients, no change in the remaining 10); normalized LV and RV stroke work were minimally depressed (70% of control); ejection fraction were minimally decreased (5%); and recovery of function occurred within 4 hours following bypass. In group II (n = 8), LV compliance decreased in all patients; RV and LV systolic function was moderately to severely depressed (40% of control); and recovery did not occur within 24 hours after bypass. In both groups, afterload reduction improved cardiac index, stroke volume index, and LV stroke work index after bypass, but the effects were more pronounced in group II patients. Preload augmentation with 1,500 ml of volume was not effective in either group when wedge pressure exceeded the normal ranges. Thus, significant ventricular dysfunction (RV and LV; systolic and diastolic) occurs during the immediate and prolonged post-bypass periods and can be predicted from the preoperative ejection fraction and degree of dyssynergy.
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PMID:Alteration of ventricular function during coronary artery surgery. 278 23

The time-dependent recovery of gonadotropin-releasing hormone (GnRH) responsiveness in desensitized gonadotropes was examined under conditions of altered membrane fluidity and GnRH exposure. Cultured pituitary cells were treated for 3 h with GnRH (10(-9) M; to provoke homologous desensitization) or vehicle alone (controls). When cells were washed and immediately rechallenged for 3 h with GnRH, gonadotrope responsiveness (assessed by luteinizing hormone (LH) release) was significantly lower in GnRH-pretreated cells than controls. If gonadotropes were allowed to recover in medium alone, membrane fluidity agents 2-(2-methoxyethoxy)-ethyl-8-(cis-2-n-octylcyclopropyl)-octanoate (A2C; 10(-4) M) or cis-vaccenic acid (CVA; 0.5 mM) or a low dose of GnRH (10(-10) M) for up to 48 h prior to rechallenging with GnRH, responsiveness in all cases was significantly lower in GnRH-pretreated cells than controls. However, if cells were treated with either A2C or CVA in the presence of GnRH (10(-10) M) during the recovery period, gonadotrope responsiveness to a subsequent challenge with GnRH was partially restored by 24 h; by 48 h no differences in the LH secretory response to GnRH was detected between GnRH-pretreated cells and controls. The possibility that restoration of the GnRH receptor-linked Ca2+ channel is associated with recovery of the desensitized gonadotrope was also examined. Identical protocols to those described above were used except that the functional integrity of the Ca2+ channel was assessed by measuring LH release in response to increasing doses of maitotoxin (MTX; a specific Ca2+ channel activator). Again, GnRH-pretreated cells were significantly less responsive to MTX than controls when allowed to recover for 48 h in medium alone, A2C (10(-4) M) or GnRH (10(-10) M). However, allowing cells to recover for 48 h under a condition of increased membrane fluidity and basal GnRH levels completely restored the MTX-stimulated LH secretory response in GnRH-pretreated gonadotropes. Taken together, these studies suggest that the physical state of the gonadotrope plasma membrane together with the appropriate hormonal milieu provide an important environment for the gonadotrope to recover from desensitization. Additionally, our results suggest that functional recovery of the GnRH-linked Ca2+ channel may play a requisite role in restoring GnRH responsiveness to the desensitized gonadotrope.
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PMID:Restoration of the LH secretory response in desensitized gonadotropes. 284 35

The effects of intravenous glycerol in elderly patients with recent onset of acute ischaemic stroke were evaluated in a double-blind randomised controlled trial. 173 patients received either 500 ml of a 10% solution of glycerol in physiological saline or 500 ml of physiological saline administered intravenously over 4 h daily for 6 consecutive days. The number of deaths within the first week was 10 (12%) in the glycerol group versus 26 (30%) in the controls. Subsequent mortality up to 12 months was similar in the two groups and a survival analysis confirmed a beneficial effect of treatment (p less than 0.02). The neurological and functional recovery of survivors, their length of hospital stay, and the proportion able to return to live in their own home were similar in the two groups. The improvement in survival time with glycerol was achieved without serious adverse effects and without an increase in the proportion of survivors with severe residual disability.
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PMID:Double-blind randomised trial of intravenous glycerol in acute stroke. 288 Feb 14

Nineteen patients with radiologically confirmed stroke, and varying degrees of hemiparesis, were studied using somatosensory evoked potentials and the recently developed technique of transcutaneous motor cortex stimulation. The functional deficit caused by stroke was assessed at the time of evoked potential testing and again on follow-up 2 months after stroke. Stroke location and degree of recovery were compared with the evoked potentials elicited an average of 8 days after the acute event. The motor response was better (p less than 0.01) than somatosensory response at predicting an outcome in terms of functional recovery, both overall and when comparing patients with similar degrees of weakness. Normal somatosensory evoked potentials also predicted recovery but were not as sensitive as the motor evoked potentials (0.01 less than p less than 0.05). Motor evoked potentials in conjunction with clinical assessment may offer a means of more accurately predicting functional outcome following stroke than can be achieved with clinical assessment, with or without somatosensory evoked potentials. The additional finding that cortically evoked motor evoked potentials were delayed only by subcortical lesions is of interest and may extend the understanding of the pathophysiological mechanism of this response in humans.
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PMID:A comparison of somatosensory evoked and motor evoked potentials in stroke. 291 30

The Stroke Data Bank (SDB) is a systematic prospective study of the diagnosis, clinical course, and outcome of a large series of stroke cases. The SDB uses an interdisciplinary approach, with neurologists, nurse clinicians, epidemiologists, statisticians, and computer scientists collaborating to study stroke research issues, including diagnosis of stroke subtypes, characterization of the course and outcome of each stroke type, and identification of nonclinical factors that influence outcome. Research questions germaine to nursing management of stroke patients include: the identification of acute stroke patients likely to develop life-threatening or recovery-impeding complications; assessment of the impact of stroke on ability to perform activities of daily living; determination of how depression affects functional recovery; and identification of quantifiable measures of stroke outcome.
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PMID:The Stroke Data Bank project: implications for nursing research. 294 98

The nursing approach in the care of stroke patients has a direct impact on functional outcome. Nursing application of Bobath principles in stroke care offers a nursing focus on involvement of the affected side; facilitation of normal tone, posture, and movement; and development of more normal function. A research study evaluating the functional gains of stroke patients demonstrated a significant level of functional improvement in those treated with Bobath principles over stroke patients treated with the traditional nursing approach. Practical methods for applying Bobath principles in patient care activities are described. These therapeutic methods provide nurses with the means to maximize stroke patients' potential and further influence their functional recovery.
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PMID:Nursing application of Bobath principles in stroke care. 295 40

In a prospective study of 86 patients with acute stroke, blood glucose and HbA1 were estimated within 72 h of onset. The prevalence of previously diagnosed diabetes mellitus was 8% whereas 28% could be assumed to have had unrecognized hyperglycaemia preceeding the acute event as identified by a stable HbA1 raised more than two SD above the mean reference value. Complete functional recovery of the limbs within 4 weeks of the stroke was confined to those patients with a normal admission blood glucose. None of the patients with a raised admission blood glucose regained full functional recovery within 4 weeks. Cumulative mortality at 4 weeks was significantly raised in patients with an elevated blood glucose value irrespective of their HbA1 values (p less than 0.05). The prevalence of unrecognized hyperglycaemia as a risk factor for acute stroke is greater than previously reported in the UK and admission blood glucose concentration is of greatest importance in predicting early mortality and morbidity.
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PMID:The prognostic value of stress hyperglycaemia and previously unrecognized diabetes in acute stroke. 295 26

Mood assessments were made after six months of 149 survivors taken from a register of all patients admitted to hospital with acute stroke. Using a General Health Questionnaire score of 12 or more as a criterion of important affective illness, its prevalence was 23%. There was no difference in risk of affective illness between left and right hemisphere strokes. Affective illness was strongly associated with functional ability, with limb weakness and with longer hospital stay in those with good functional recovery. Only 15% of those with high scores were receiving antidepressant drugs. The general practitioner is in the best position to detect psychiatric illness in stroke survivors; the use of mood rating scales such as the GHQ, in conjunction with clinical assessment, may improve detection.
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PMID:Affective illness after stroke. 296 Apr 13

As evidenced by their ability to reduce cerebral edema, exogenous ganglioside administration exerts acute effects on CNS injury processes. We report here that ganglioside (GM1 or AGF2) treatment results in a 52% decrease in mortality 48 hours after the induction of ischemia in gerbils by permanent unilateral ligation of the common carotid artery. By comparing the occluded vs. nonoccluded sides of the brain (cortex and hippocampus) we found a significant loss of membrane Na, K-ATPase activity due to ischemia in control animals, but no such differences were found between the hemispheres of ganglioside-treated gerbils. We hypothesize that gangliosides may be "protecting" membrane function as indicated by these ATPase analyses, reducing local CNS damage at the time of injury (i.e., reduced cell loss, fiber degeneration, membrane failure). By acutely limiting the extent of CNS tissue damage, conditions may be optimized for any subsequent CNS regrowth and functional recovery.
Stroke
PMID:Gangliosides (GM1 and AGF2) reduce mortality due to ischemia: protection of membrane function. 302 26

Two hundred and six patients with acute stroke admitted consecutively to District General Hospitals, were studied for a period of six months. Significance tests conducted singly detected 21 factors present during the first 48 h of stroke, which were related to outcome six months later in terms of both mortality and functional recovery. Among these significant factors were various measures of perceptual dysfunction, including Albert's Test. Multivariate statistical analysis which included discriminant analysis and linear logistic modelling, revealed six factors (Albert's Test Score, leg function, level of consciousness, arm power, weighted mental score and ECG changes) which were significantly and independently related to outcome. A statistical model based on these factors predicted functional outcome with an overall accuracy of 67 per cent and mortality with an accuracy of 83 per cent. This model provides a useful basis for stratification in future randomized controlled trial in stroke, and may have a role in the management of the individual stroke patient.
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PMID:Prognostic indices in stroke. 317 26


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